Severn Deanery Experiences Page
This is a collection of experiences from all grades of doctors- surgical trainees and consultants. This page has been developed as informative of different experiences from trainees in surgery. It is supposed to be supportive and relevant to those who are embarking on a career in surgery and those who are already.
If you would like any more information or would like to contribute further please email firstname.lastname@example.org
Julia and I married in 1981. She was a lawyer and I was a registrar in ENT surgery. Our first child was born in 1983, and our second in 1989. I was appointed a consultant in 1987. In 1988 Julia went back to University to do an MBA and in 1990 went on to manage a division of a major law firm in Chancery Lane, London weekly commuting from Bath. After two years she returned to work in Bristol, daily commuting from Bath for several years before taking up an appointment as a teacher, then head of A level Economics and Business Studies in a local school. Throughout this time we/I have experienced the whole nine yards of working with family commitments: as a surgical trainee with a working wife, with and without children; as a consultant with a wife not working, part-time working and full time working; with au pairs, with nursery care, including having to look after and feed a new born at night, whilst on call, when Julia was in London. None of them are perfect. Julia was also the subject of an academic study looking at senior women managers so I have had the rather odd but illuminating experience of reading about our own family life. (Women Managers Moving On; Exploring Career and Life Choices. Professor Judi Marshall. Routledge 1995 ISBN 0-415-097329-8)
For some, having a family appears to be the main purpose in life. Alternatively, a family can be the point from which you and your family go and explore the world. We have friends who have apparently taken the view that having a family as the main purpose in life. They have gone off into the countryside to raise children in “idyllic” surroundings, and effectively disappeared from our lives without trace. There is nothing wrong with this approach but it hasn’t appealed to me very much. In contrast, there have been other friends who have both relentlessly pursued careers, ignored their children until one day they are picking them up from the police station or receive a letter from a divorce lawyer. Of course, these are both extremes and the trick has to be getting the balance between the two. This is far from easy.
If I am honest, Julia has been much better at doing this. Whilst in a full time career and commuting to London, with a young family in Bath she was interviewed for the book and talked about “having two half lives…and half and half didn’t amount to one at all.” This meant a loss of “balance” and she changed career to “see more of my children and my husband.” Very sobering to read this because it meant a great loss of personal prestige for her by resigning her very senior position in law. Although she never asked me to make changes to my job, I am not sure I could have done the same. I remain very conscious that I owe her a lot in recognising that all was not well and reacting to the situation. Getting a good balance between family and work in surgery and law, whether you are male or female, can be very difficult to achieve although it is arguably getting a little bit easier than it was twenty years ago.
My own attempts to check out that my children were not well on their way to the drug rehabilitation centre or the law courts look pitiful when I look back now. About once every two years I would interview them on video. It started off as a fun experiment but grew into quite extensive friendly reviews of what was happening to them. Towards the end, I always slipped in the question, “what do you think of me as a father?” I was always reassured by their answers. Gradually over time it gave me the confidence to ask that and similar difficult questions much more often than every two years.
The other fun approach was spending whole days together, one parent with one child. We wanted to give them some measure of control over their own lives, so when they were seven we agreed that they could take one or two days off from school every year and, with sufficient notice, I would arrange to have the same day off. After explaining to the teacher that “so and so” was not seeing enough of their father, therefore I was planning to put this right. On the appointed day we would waive everyone else off to work and, accompanied with a delicious sense of naughtiness for skipping school, I would say “I am yours for the day. What do you want to do?”
My daughter told me many years later when she was in her twenties, that by taking these “special” days she always knew that she could have access to either parent whenever she really felt the need to talk. She told me she would use these occasions to ask us about really difficult issues in her own life. I was never aware of this happening, which I guess is what happens when you spend a whole day with someone just gossiping away together. In time we developed other ways of doing this by dividing up the weekend into time together, time with one child and time alone. Then later still they became parent/child holidays which my wife and I would take individually with a single child to go to Africa, New Zealand or Greece or whatever. Even though they are now both adults, longer holidays together still happen occasionally and having supper in a restaurant with just one of your children is particularly special.
Of course I could and should talk about the need to share the load of work in family life but fortunately I am pretty good at it….actually damn near perfect or so I thought. Recently several friends and acquaintances have unexpectedly split up. This prompted me to ask Julia if she had ever thought of leaving me. “Yes, of course,” she replied, “about once every week!”
To make sure that what I was saying was credible, I have showed what I have written to my wife and both children. My children, twenty nine and twenty three, say that they now realise that the very busy lives they lead, and the expectations they have in their partners, owe a lot to the way we have lived life as a family. Julia suggested that I change the section on leaving me to “once every fifteen minutes!”
So, after thirty one years of marriage, career and family life the main impression I have is about managing the mess, maximising the fun wherever possible, and making sure that you always continue to communicate through talking, laughing and arguing and even fiercely arguing as often as possible. For the opposite of love isn’t hate, it’s indifference.
“Striking a balance and learning to say no”
One of the key challenges of my lecturers post has been striking the balance between clinical and research work. Pressures of clinical work can make it difficult to focus on research and can prevent effective progress. To prevent this I initially divided my research and clinical work into alternating weeks to ensure a 50:50 split whilst also participating fully in the general surgery on call rota. In my second year a change in the on call rota made this pattern of work unsustainable and I moved to a split week format.
The division of work has only been possible because of a supportive clinical team of consultants and registrars who understand my dual commitments. A concerted effort is made to ensure I am trained; that I optimise my operative learning opportunities and maintain agreed targets whilst providing support to the clinical service. My academic supervisor, Jane Blazeby who is also an Upper GI surgeon has been central in facilitating this approach.
It has not all been plain sailing and learning when to say ‘yes’ and when to say ‘no’ is difficult. There are competing pressures of undergraduate and post graduate teaching, meeting organisation, management of clinical issues as well as research. Regular review and monitoring of commitments in discussion with both my academic and clinical supervisors is critical, full utilisation of every clinical and research opportunity is key as is ring-fenced time away from both.
I decided to become a surgeon at an early age. The reason (which I never give in interviews) must be that my father was a surgeon and was very good at telling gory stories and it was clear how immensely rewarding surgery was he came home beaming with another heroic story and a bottle of wine from a grateful patient.
My initial reasons for doing surgery may have been a little naive, but I haven’t changed my mind since.
I have had my wobbles where GP looked like an easier option especially when the work life balance was not very balanced at all. But I would think about clinic all day, every day without any operating to look forward to and I would soon snap out of it. I cannot remember ever feeling limited and thinking 'I cannot do this because, I am a woman'. I just thought I can't do it the way Dad has, as I want to see my family a bit more, so I'll just do it my way. Even when an old fashioned consultant warned me 'you can’t be a good surgeon and a good mother.' I thought how silly and laughed it off.
I have enjoyed surgery even more since becoming a mother. I think it is because you have time out of the hamster wheel to re-assess what you really want from life and absence did make my heart grow fonder for surgery. I decided to go back LTFT as my husband is an anaesthetist and with no family nearby, I did not like the idea that my son would be looked after by someone we did not know for at least five days a week. With the early starts and unpredictable finishes with surgery I also did not like the idea that potentially I would only see my son at the weekends. The good things about LTFT is that when I’m at work I'm more enthusiastic than I ever was when working full time as I am determined to make every day count - improving my logbook, getting an audit finished, staying for an extra case that is going to finish late. I don’t feel guilty about finishing late and not getting home for bath time as I do it four days a week anyway. My training is going to be greatly prolonged as I will be doing almost all of it LTFT, but I’m not sure I would have felt ready to be a consultant at aged 34 anyway, this way I get to do many more jobs and hopefully be a bit older and wiser by the time I get there!
I started out my career as an SHO in obs and gynae and my rotation had a year of general surgery and urology sandwiched in the middle. I had always enjoyed most specialties, but when I did colorectal surgery I felt like the kind of doctor I wanted to be and realised I had missed treating the variety of patients and the challenge of managing very unwell patients with co morbidity.
I made up my basic surgical training rotation through stand alone jobs as I had been an SHO for some time by then and only needed 6 months of orthopaedics and 6 months of another specialty. After 4 years as an SHO I got a Trust grade registrar job in Newport, Gwent which helped me when the MTAS fiasco hit as I had some registrar experience.
Since then I have been a higher specialist trainee in the Severn region, although I did take a year out of programme (OOPE) as the Clinical Fellow in Postgraduate Medical Education at North Bristol. I did this as I felt I needed a bit of space to reflect on my career path and I wanted to develop my interest in education. This was a good opportunity to design teaching programmes and do some educational research, amongst other things, which I maintain an interest in still. However, after coming off the on call rota for a while I realised that I personally felt I had more integrity as a teacher when dealing with emergencies regularly and I really missed my clinical work.
I try to juggle my career in surgery with spending time with my family, my partner and my stepson. I often wish there was more time for painting and hill walking, ironically considering the British weather I make more time for the latter than the former as when I am at home I tend to feel I should prioritise working for my Diploma in Medical Education or trying to publish papers. I am not as effective as I should be and sometimes I resent what feels like jumping through hoops, but ultimately I remain passionate about colorectal clinical work and postgraduate medical education and surgical training.
I honestly never considered myself to be a ‘women in surgical training’ until my first ARCP when I’d returned to work after maternity leave. I remember being asked what my other half did for a living, what time he started work and what child care arrangements I had. It didn’t occur to me until afterwards that my male colleagues probably weren’t asked about that.
Let’s face it being a girl suits the first SHO/CT years of training. We are friendly to have around, super organised, polite and work well within the team. Getting a reg/ST job is as competitive as it’s always been and should remain so. Sure I often didn’t feel as confident as the guys appeared to be, and I couldn’t work out why they claimed to have done so many more procedures. My advice would be to forget about everyone else and focus on your training. Remember probity makes up a big part of revalidation. Having now taken juniors through operations myself it is often easier to train the less gung ho.
During my first registrar years I did find it difficult to fit in. The conversation between cases is often sport related and I didn’t/don’t have much common ground with my consultant. Simple things like knowing the code for the ladies changing room and working out if the boss is still getting changed or already on the ward round can be unsettling. The other thing I still struggle with is people’s perception of me. The patients always presume my tall SHO is the surgeon and even nurses who I’ve worked with for many years are surprised I perform the operations. There’s nothing more unnerving than the ODP leaning over and saying “Oh, they’re letting you do this one alone are they?”
I have had two girls and there is a fifteen month gap between them. I figured it would be better for my training to have them close together (that surely must show commitment to surgery). I had six months of maternity leave with each. Orthopaedics and being on call whilst pregnant is hard. I was extremely tired, especially with the second pregnancy and know my CV, research and audit suffered as a result. Returning to work was ok, and certainly after my second pregnancy I was looking forward to it. Personally, I don’t think you can train part time in surgery. I chose a nursery that is open from 07.30 to 18.30 and those extra hours make a big difference. I am very fortunate my other half can usually do the drop off and pick up.
One thing I have learnt is not to try and get home for a certain time. You will end up disappointing your partner, get frustrated yourself and annoy your consultant. Resign yourself to the fact that some days you won’t see your children and if you do it’s a bonus. I am slightly irked that if a guy has to pick up the kids the feeling in theatre is that of sympathy. Where as if I have to pick up my children, eyebrows are raised and mutterings of ‘typical’ can be heard.
After the training is complete, there’s the exam and the fellowship. This is hard and stressful no matter what your gender or family situation. We all have to work at home with little ones at the door saying, “Mummy/Daddy please don’t work and come play”. My advice would be to sit down and explain to your significant other a year in advance what they will need to do to help out. Get organised and plan your revision.
As I write this I am in New York and my family is back home in the UK. I’m here for about a month by myself and this is definitely the hardest part of my training so far – the fellowship. At my last ARCP I was introduced as the one who’s ‘not very movable’. Historically registrars have moved to Oz for a year and I feel like I’m judged badly for not doing the same. But I don’t want to go, not just because of uprooting my children but I have to consider my partner’s job and the grandparents. Does this make me a bad surgeon or trainee? I’d like to think not. As more women and different personalities come into surgery, the way in which we train and the way fellowships are approached will need to change and become more flexible as they have in other professions.
Don’t misunderstand me, I don’t feel I’ve ever been discriminated against because I’m a girl (if anything it has been positive discrimination at times). I think in surgery there is a stereotypical phenotype which if you don’t fit into, for whatever reason, can make you feel on the periphery. For those people on the outside, find a similar mentor who you can confide in. For those on the inside just be aware that in life and surgery it really does take all sorts. As we adapt our styles to get the best history from our patients perhaps we should adapt our communication to get the best from our colleagues.
At the end of this I don’t want to sound like a staunch feminist, because for 90% of the time I forget I’m a girl. And those of you who know me understand I love my job. I am thankful I get to do something I enjoy so much and proud I’ve nearly finished my training without too much whinging.
I decided surgery was for me when I first contemplated medicine. I loved the dexterity, acuteness and the patient contact. I adore surgery. I enjoy my work, clinical duties and the operating theatre. I have been extremely lucky with the fantastic and supportive teachers and surgeons I have worked with.
I decided to have a baby at a core surgical level as there is a family history of infertility. I knew that I would regret it if I wasn’t able to conceive when my career was right and it was a great time for my husband and I. But as I am about to embark on the next stage for Spr posts, I do feel the extra added pressure, as we will all have to make changes if I do not get the post I want.
I returned back to work full-time and after 6 months maternity leave. Part of the reason for this was financially, and also I wanted to see if it was feasible, before I contemplated LTFT. I have been back to work now for 8 months and it works for our family. My son is in a routine and goes to bed late so I always (apart from on-calls) see him every night. At the moment, I do his morning routine because I work within an hour of our home. It works for now, but we are aware that we might have to change in the future.
For us, the key is teamwork. My husband is my rock eg. dropping off and picking up my son at nursery and keeping the house functioning whilst I’m on-calls/nights. However, I do reciprocate! He plays for a national team and is away frequently. Whilst on nights, I have the pleasure of picking up my son from nursery which I never do! The day post-nights I always stay up and go to soft play and catch up with the mothers from my other life. They find it hilarious that surgeons are humans too and can sing “incy wincy spider.”
I have found some negativity which I was surprised about. Mostly from female peers who don’t agree with my decisions of full-time and career choice. However I have a lot of support from my seniors, family and friends which makes up for it. But it does affect me nevertheless.
For my family, the key is flexibility. Our son is in a routine that is working at the moment, but we might need to change things as he gets older. I love my job, my family are happy and my son is thriving, so I know I have made the right choice.